CHEST Guidelines-Sepsis-in-Immunocompromised-Host-and-a-Hematologic

Sepsis-in-Immunocompromised-Host-and-a-Hematologic

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This medical case study describes a 43-year-old Puerto Rican man with a kidney transplant who developed a life-threatening condition involving sepsis and a hematologic complication while immunocompromised. The patient initially presented with symptoms suggestive of pneumonia and underwent plasma exchange for a transplant rejection, managed on heightened immunosuppressive medication. He was discharged with doxycycline but returned to the hospital with more severe symptoms including fever, chills, dyspnea, and a rash, alongside deteriorating kidney function and blood work abnormalities.<br /><br />Advanced imaging revealed multifocal pneumonia and other signs indicative of a severe systemic infection. Despite treatment with broad-spectrum antimicrobials and voriconazole, the patient's condition worsened, developing severe anemia, thrombocytopenia, and requiring intensive care and hemodialysis.<br /><br />Pathologic findings from bronchoscopy and a skin rash biopsy identified the presence of fungal microorganisms consistent with histoplasmosis. Further investigation using a bone marrow biopsy and immunological markers led to the diagnosis of disseminated histoplasmosis complicated by hemophagocytic lymphohistiocytosis (HLH), a rare but severe condition where the body's immune system becomes overactivated, leading to excessive inflammation and tissue damage.<br /><br />The clinical presentation was compounded by the patient's immunosuppressed state and prior kidney transplant. The case highlights the importance and utility of considering HLH in patients presenting with severe infections and multiple organ dysfunction, especially when they are immunocompromised. The patient showed a positive response to treatment with corticosteroids and intravenous immunoglobulin, which are preferred for managing HLH secondary to infection, in this case, histoplasmosis.<br /><br />This study emphasizes the value of early recognition, comprehensive evaluation, and a targeted treatment approach for HLH, particularly in complex cases involving multiple underlying conditions.

Keywords

kidney transplant

immunocompromised

sepsis

hematologic complication

histoplasmosis

hemophagocytic lymphohistiocytosis

broad-spectrum antimicrobials

immunosuppressive medication

corticosteroids

intravenous immunoglobulin